Dóra Batta1, Ádám Tabák2, Orsolya Cseprekál3, József Egresits4, István Kiss5, András Tislér6, János Nemcsik7
1 Department of Family Medicine, Semmelweis University
2 1st Department of Medicine, Semmelweis University; Department of Epidemiology and Public Health, University College London, London, UK
3 Department of Transplantation and Surgery, Semmelweis University
4 Department of Internal Medicine and Cardiology, Klinikum Klagenfurt, Klagenfurt am Wörthersee, Austria,
5 B Braun Avitum Hungary CPLC, Nephrological Network, Hungary; Division of Nephrology, Department of Medicine, St. Imre Teaching Hospital; Division Section of Geriatrics, 2nd Department of Medicine, Semmelweis University
6 1st Department of Medicine, Semmelweis University
7 Health Service of Zugló (ZESZ)
Introduction: Arterial vascular stiffness and central blood pressure are potential tools in cardiovascular risk assessment. Different values resulting from many available methods, however, make the emergence of an international consensus difficult.
Aim: To develop an integrated central pressure-stiffness (ICPS) score to predict cardiovascular events.
Methods: One hundred chronic kidney disease (CKD) patients on conservative therapy were included in our study. Pulse wave velocity (PWV), central systolic blood pressure (cSBP) and central pulse pressure (cPP) were measured. A score was assigned to tertiles of PWV (0 to 2), cPP (0 to 2) and cSBP (0 to the first and second and 1 to the third tertile) based on each parameter’s ability to individually predict cardiovascular outcome. The sum of these scores (ICPS) and three ICPS risk categories as predictors were studied. Finally, we compared discrimination of the ICPS risk categories with that of the Framingham CVD score.
Results: High (ICPS score 3 to 4; n=37) and very high ICPS risk categories (ICPS score 5; n=12) had increased cardiovascular risk (HR: 4.95, 95%CI: 1.97-12.42, HR: 9.73, 95%CI: 3.06-20.23, respectively) compared to the average risk group (ICPS score 0 to 2; n=51). The very high ICPS risk category remained an independent predictor (HR: 4.87, 95%CI: 1.81-13.08) in a model further adjusted for Framingham CVD score (HR: 1.66, 95%CI: 1.13-2.43 per 1 SD increase). When comparing discrimination of the Framingham score (Harrell's C: 0.704, 95%CI: 0.625-0.784) and with ICPS added to the Framingham score (C: 0.729, 95%CI: 0.647-0-810), the difference was not significant probably due to the limited power of our study.
Conclusion: The ICPS score may clinically importantly improve the identification of CKD patients with elevated cardiovascular risk, but larger studies are required.
Doctoral School: Doctoral School of Pharmaceutical Sciences
Program: Experimental and Clinical Pharmacology
Supervisor: János Nemcsik
E-mail address: email@example.com